Borderline Personality Disorder
Borderline personality disorder, or BPD, is a psychiatric disorder characterized by mood instability, impulsive behavior and difficulties with relationships. The symptoms usually appear in adolescence or young adulthood, but may begin to be evident in childhood.
Risk Factors for BPD
The precise causes of borderline personality disorder are unknown, but there seem to be genetic and environmental factors at play in the development of the condition. Studies of twins have demonstrated a hereditary link to the disorder. In patients with BPD there appear to be abnormalities on the genes regulating emotions and impulse control. Females are three times more likely to be diagnosed with BPD than males.
As with other psychiatric disorders, once there is a genetic predisposition, environmental disturbances may increase the patient's risk of developing the disorder. Environmental risk factors for BPD include:
- Sexual abuse
- Abandonment or traumatic loss during childhood
- Unstable family relationships
Symptoms of BPD
Patients with BPD present as troubled personalities. Because of their constant fear of abandonment, their doubts about self-worth, and their inability to be alone, they are often unable to establish or maintain comfortable relationships. Once involved in a relationship, patients with BPD tend to become obsessive, either idealizing or totally devaluing the other person. Other symptoms of this disorder include:
- Self Injury
- Feelings of emptiness, boredom or dissociation
- Suicidal threats
- Impulsive, risk-taking behavior
- Inappropriate explosive anger
- Extreme emotional reactions to ordinary events
- Intense and stormy relationships
- Paranoid thoughts or feelings
- Distress over minor separations
A very high percentage of patients with BPD are troubled by other psychiatric disorders as well. Female patients with BPD often present with major anxiety, depression, or eating disorders, while male patients with the condition are frequently substance abusers or have a dual diagnosis or BPD and antisocial personality disorder.
Diagnosis of BPD
Borderline personality disorder is often difficult to diagnose because patients frequently misrepresent their symptoms. Many times patients with BPD believe their trouble is caused by other people or do not perceive their own behaviors as abnormal. Skilled mental health care professionals are usually able to diagnose BPD after a thorough psychological assessment.
Treatment of BPD
A combination of psychotherapy and medications is typically used for treating borderline personality disorder, but this also presents problems because patients with BPD may stop treatment or may not be medication compliant.
No medication has been approved to treat the disorder itself, but medications may be prescribed to provide relief from symptoms of anxiety, depression or mood instability. One study has shown Omega-3 fatty acids to be of assistance in alleviating symptoms of depression and aggression in women with BPD.
Several types of psychotherapy have been found to be especially useful for patients with BPD. These include:
- Cognitive behavioral therapy
- Dialectical behavior therapy
- Schema-focused therapy
All of these types of psychotherapy are designed to guide patients to be aware of their behavior in the present, to reduce their self-destructive impulses, to change their damaging belief systems and to improve their social interactions. For those who commit to a course of treatment, the outlook is hopeful.
Risks of BPD
Poor judgment and impulsivity may result in patients with BPD putting themselves at risk. Unfortunately, a patient with this disorder is much more likely to be a victim of rape or other violent crime than the average person. Such patients are also at increased risk of attempting or committing suicide.
- National Institutes of Health
- Centers for Disease Control and Prevention
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
- U.S. Department of Health & Human Services
- U.S. National Library of Medicine
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